| NPI | 1750684957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT002865) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT 013110) |
| Enumeration Date | 2010-12-09 |
| Last Update Date | 2016-05-27 |